HB 5938 Summary

• Establishes the "Pharmacy Benefit Manager Licensure and Regulation Act" requiring all pharmacy benefit managers serving Michigan residents to obtain and maintain a biennial license from the Department of Insurance and Financial Services.

• Requires pharmacy benefit managers to submit annual transparency reports detailing rebates received from manufacturers, fees collected, aggregate retained rebate percentages, and wholesale acquisition costs, with director authorized to conduct annual reviews of de-identified claims data.

• Mandates pharmacy benefit managers maintain reasonably adequate and accessible pharmacy networks, provide good faith and fair dealing in contracts, update maximum allowable cost lists at least weekly, and establish appeals processes for pharmacy reimbursement challenges.

• Prohibits pharmacy benefit managers from penalizing enrollees or imposing different access limits based on ownership interests in pharmacies, and prevents restrictions on pharmacy participation from the federal 340B Program.

• Authorizes the director to suspend, deny, restrict, or revoke licenses for violations, with fines up to $5,000 monthly for suspended or restricted operations, and requires department to file aggregate annual reports to legislature without disclosing proprietary information.